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General NPI Number Information
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NPI Number | 1669931028
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Entity Type | Individual
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Provider Name | BONNIE WALKER HUDSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 1000 BRABHAM AVE
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5003
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Country | US
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Telephone | 910-341-3300
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Fax | 910-251-2067
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Provider Business Mailing Address
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Address Line | 1000 BRABHAM AVE
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5003
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Country | US
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Telephone | 910-341-3300
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Fax | 910-251-2067
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | HUDS-7L88M5
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | J5011593
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License Number State | NC
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